高频重复经颅磁刺激治疗对抑郁症患者运动阈值影响及与疗效的相关性

目的探讨高频重复经颅磁刺激治疗抑郁症患者时对患者运动阈值的影响及与疗效改善的相关性。方法使用10Hz重复经颅磁刺激对44名抑郁症患者治疗2周共10次,测定治疗前和治疗后患者的运动阈值,使用HAMD和HAMA评定患者治疗前后的临床症状。并测定60名健康对照组的运动阈值与患者相比较。结果抑郁症患者左侧和右侧运动阈值和正常对照相比均有显著性差异(左侧:t=-4.44,P=0.00;右侧:t=-5.15,P=0.00),抑郁症患者组的运动阈值低于正常对照组。正常对照组运动阈值左侧低于右侧,即左侧兴奋性高于右侧,差异有统计学意义(t=-3.38,P=0.00);抑郁症患者左右侧运动阈值相比无差异(t=-1.14,P=0.26)。经颅磁刺激治疗前后患者汉密尔顿抑郁量表评分,差异有显著统计学意义(t=6.19,P=0.001);汉密尔顿焦虑量表评分,差异有显著统计学意义(t=5.73,P=0.001)。治疗前后运动阈值无变化。抑郁症患者右侧运动阈值与汉密尔顿抑郁量表评分呈负相关(r=-0.39,P0.05)。结论抑郁症患者皮层兴奋性比正常对照组高,左右偏侧性消失;运动阈值与临床症状变化无相关性。     

晚发性精神分裂症患者双侧额叶指数的对照研究

目的对照观察晚发性精神分裂症(LOS)患者双侧额叶指数(FI)的改变。方法 84例LOS患者进行头颅CT扫描后、测定双侧FI,与84例性别、年龄匹配的健康人进行对照,并分析FI与LOS患者临床特征的关系。结果①患者组左、右侧FI值均显著高于对照组的同侧值(t=2.117,2.054;P0.05);②单因素分析显示,患者组左侧FI与年龄(r=0.313,P0.05)、PANSS总分(r=0.270,P0.05)、阳性因子分(r=0.284,P0.05)正相关;右侧FI仅与年龄正相关(r=0.298,P0.05);③线性回归分析显示,患者组左侧FI与年龄、PANSS量表阳性因子分正相关(β=0.073、0.006,P0.01);右侧FI仅与年龄正相关(β=0.065,P0.01)。结论晚发性精神分裂症患者可能存在双侧额叶的萎缩,且左额叶改变与临床特征更有内在联系。     

垂体大腺瘤对后视路影响的功能磁共振成像和弥散张量成像联合研究

目的 采用弥散张量成像(DTI)和功能磁共振成像(fMRI)方法对垂体大腺瘤患者后视路的结构和功能进行评价,分析垂体大腺瘤对视放射和视觉皮层的影响.方法 采用1.5T磁共振扫描仪对23例垂体大腺瘤患者(患者组)及18名健康志愿者(对照组)进行组块设计的fMRI和DTI检查.fMRI刺激内容为全视野黑白翻转棋盘格,对照内容为黑色屏幕中心的白色"+",左右眼分别进行试验.采用SPM2进行fMRI数据后处理,通过组间分析方法分别获得左眼及右眼刺激下患者组与对照组间的激活差异图.DTI扫描采用13个弥散敏感梯度,b值为1000 s/mm2.采用Volume-one软件进行后处理,测量两侧视放射的FA值,分析两组间视放射FA值的差异.结果 在严格控制头动和机械噪声等影响因素后,最终各入组12例.患者组与对照组比较,初级视觉皮层激活范围及强度均明显缩小.且以对侧视觉皮层激活下降为主(P<0.05).患者组左侧及右侧视放射FA值均明显小于对照组(左侧:0.52±0.06比0.58±0.04,t=3.45,P<0.01;右侧:0.50±0.05比0.60±0.04,t=5.77,P<0.01).结论 垂体大腺瘤患者可发生后视路的微观结构改变和功能下降,而联合应用DTI和fMRI有助于早期了解这种脑结构与功能变化.     

多发性硬化和视神经脊髓炎的脑灰质结构分析

目的 利用基于体素的形态学测量(VBM)和基于皮层的脑形态学测量(SBM)方法对多发性硬化(MS)和视神经脊髓炎(NMO)患者脑灰质体积及皮层厚度进行比较分析,探讨这两种疾病的脑灰质结构变化的差异。方法 对21例MS患者,16例NMO患者以及19例健康对照者行磁共振常规序列扫描,基于Matlab2014a平台的统计参数工具SPM12以及SPM12下的小工具CAT12,对VBM和SBM方法处理的数据进行分析。结果 MS组与正常对照(NC)组相比,经高斯随机场(GRF)校正后,MS组在左侧枕上回、左侧楔叶、左侧距状皮质、左侧楔前叶、左侧中央后回、左侧中央旁小叶、右侧楔叶、左侧额中回、左侧额上回和左侧额内侧回灰质体积显著性减少(P<0.05);经族系错误(FWE)法校正后,MS组在左侧中央旁小叶、左侧额上回和左侧楔前叶皮层厚度显著性减少(P<0.05)。NMO组与NC组相比,经GRF校正后,NMO组在左侧中央后回、左侧中央前回、左侧顶下小叶、右侧中央前回和右侧额中回灰质体积显著性增加(P<0.05);NMO组在左侧枕中回、左侧枕上回、左侧颞下回、右侧枕中回、左侧额上回眶部、...     

31例抑郁症患者探究性眼球轨迹运动分析

目的探讨抑郁症患者探究性眼球轨迹标记运动的临床特征。方法应用探究性眼球轨迹运动标记记录仪(Type-Ⅳ)和汉密尔顿抑郁量表(HamiltonDepressionScale,HAMD)对31例抑郁症患者于治疗前后分别进行两次检查,间隔时间(34±8)天;31例正常人对照组只作一次检查。结果判别分析值(Discriminantanalysis,D分值)在抑郁症组前后两次检查的结果(0.52±1.58,0.79±1.44)均高于正常人对照组(-1.00±0.85),差异均有统计学显著性(t=4.40、5.80,P<0.01)。抑郁症组前后两次检查HAMD量表评分差异有显著性(32.14±5.72,17.48±7.82,t=11.91,P<0.01),但前后两次探究性眼球轨迹运动主要指标之间比较其差别无显著性(P>0.05)。结论抑郁症组与正常对照组探究性眼球轨迹运动结果不同,抑郁症组经过抗抑郁剂治疗后,探究性眼球轨迹运动主要指标前后两次比较无明显变化。     

首发抑郁症患者海马质子磁共振波谱成像研究

目的:探讨首发抑郁症患者海马的磁共振质子波谱(1HMRS)特点.方法:应用1HMRS成像技术检测21例未用药首发抑郁症患者和14例健康志愿者海马N-乙酰天门冬氨酸(NAA)、胆碱(Cho)、肌酸(Cr)3种代谢物,计算NAA/Cr和Cho/Cr比值.结果:首发抑郁症患者组双侧海马NAA/Cr比值低于对照组,差异有统计学意义(右侧:0.88±0.29/1.37±0.51,P=0.004;左侧:0.76±0.33/1.40±0.99,P=0.034);Cho/Cr比值两组间无统计学差异(P＞0.05);双侧海马NAA/Cr和Cho/Cr与抑郁严重度无相关性(P＞0.05).结论:首发抑郁症患者可能存在双侧海马神经元活力和功能下降.     

抑郁症缓解期患者自我和谐与应对方式

目的探讨抑郁症缓解期患者自我和谐与应对方式的关系。方法选取50名符合国际疾病诊断与分类第10版诊断标准的缓解期抑郁症患者,选取40名年龄、性别匹配的正常对照者。采用自我和谐量表(SCCS)和简易应对方式问卷(SCSQ)对患者组和对照组进行评定。结果与健康对照者比较,缓解期患者在自我与经验的不和谐、自我的刻板性、自我的灵活性及总分上存在统计学差异(t=2.435,2.502,-2.051;P0.05;t=3.262,P0.01);与健康对照者对比,缓解期患者的积极应对和消极应对评分存在统计学差异(t=-2.485,P0.05;t=3.372,P0.01);患者组积极应对方式与自我与经验不和谐及自我和谐总分呈显著负相关(P0.05);消极应对方式与自我和谐总分及各因子分均显著相关(P0.05)。结论抑郁症缓解期患者自我和谐程度较低,患者较多的采用消极应对方式。     

注意缺陷多动障碍儿童磁共振成像的低频振幅特点及性别差异

目的:探讨注意缺陷多动障碍(ADHD)儿童静息态脑功能特点以及可能的性别差异。方法:选取38例ADHD儿童(男31例,女7例)及性别、年龄匹配的正常对照42名(男29例,女13例)。使用ADHD评定量表评定症状严重程度,磁共振成像收集静息态数据。采用部分低频振幅(fALFF)评价静息态脑区活动水平。采用协方差分析比较主效应及交互效应。结果:ADHD儿童右侧内侧额上回、右侧辅助运动区的fALFF值高于对照组;左侧壳核、双侧小脑及双侧楔前叶的fALFF值低于对照组(校正P0.05)。ADHD男孩左侧小脑的fALFF值低于对照男孩,双侧内侧额上回的fALFF值高于对照男孩(校正P0.05);ADHD女孩双侧小脑及左侧丘脑的f ALFF值高于对照女孩,左侧岛叶的fALFF值低于对照女孩(校正P0.05)。ADHD女孩左侧小脑的fALFF值和注意缺陷得分负相关(r=-0.89,校正P0.05)。结论:ADHD儿童与正常对照在静息态脑功能存在差异,同时存在性别差异。     

褪黑素水平对抑郁症患者下丘脑-垂体-肾上腺轴功能的影响

目的探讨抑郁症患者褪黑素(MT)水平对下丘脑-垂体-肾上腺轴(HPA)功能的影响。方法对86例抑郁症患者,检测血清MT、促肾上腺皮质激素释放激素(CRH)、促肾上腺皮质激素(ACTH)、皮质醇(COR),并分析其相互关系。结果1以MT中位数(51.3ng/L)为切点,将所有抑郁症患者分为MT高值组(51.3ng/L,n=43)与MT低值组(51.3ng/L,n=43),前者血清CRH、ACTH、COR均显著低于后者(t=3.330,3.315,2.314;P0.01,0.01,0.05);2血清MT水平与CRH、ACTH水平负相关(r=-0.414,-0.329;P0.01,0.05)。结论褪黑素对抑郁症患者的HPA轴功能可能有一定的抑制作用。     

抑郁症患者脑电地形图改变对认知功能及与疗效的影响

目的:探讨抑郁症患者额颞叶脑电功率改变与认知功能及疗效的关系。方法:对40例抑郁症患者入院1周内行脑电地形图检查,并和32例正常对照组进行对照分析;同时对患者在治疗前后进行汉密尔顿抑郁量表(HAMD)评定。结果:(1)研究组额叶脑波α1(t=2.243,2.968,3.688,3.918),δ(t=3.639,2.517),θ(t=2.519,3.613,3.730)功率明显高于对照组,差异具有统计学意义(P0.05);(2)研究组颞叶脑波α2(t=-2.103,-2.944,-3.200,-4.548),α3(t=-3.102,-2.752,-3.047,-4.094),β(t=-3.015,-2.584,-3.842)功率明显低于对照组,差异具有统计学意义(P0.05);(3)左前额δ波功率与第2周末HAMD减分率有显著负相关(t=-2.429,P0.05);(4)左前额及右前颞β波功率、左前颞δ波功率与第6周末HAMD减分率有显著负相关(t=-2.365,-3.107,-3.979;P0.05);(5)右中颞δ波功率与第6周末HAMD减分率有显著正相关(t=2.248,P0.05)。结论:抑郁症患者存在额颞叶功能损伤影响认知功能;其抗抑郁剂治疗起效时间可能与左前额δ波功率有关;左前额及右前颞β波功率值可作为疗效的观察指标之一。     

Cross-correlation studies of movement-related cortical potentials during unilateral and bilateral muscle contractions in humans

A useful method of studying the degree of association between two signals of varying amplitude in the time domain is to use cross-correlation analysis. We applied this to the movement-related cortical potentials digitally filtered so as to eliminate the low frequency component before applying it during maximal unilateral left (UL L), unilateral right (UL R) and bilateral (BL) contractions in I I right-handed subjects. The recording electrode sites were over the right and left motor cortex areas (C3 and C4). The BL condition revealed higher cross-correlation levels of cortical activities between the two hemispheres than in UL L or UL R contraction [UL L, r = 0.68 (SEM 0.05); UL R, r = 0.73 (SEM 0.03); BL, r = 0.76 (SEM 0.02)]. The UL R revealed a positive phase difference [5 (SEM 2) ms] when the maximal cross-correlation coefficient was shown and UL L showed a negative phase difference [5 (SEM 3) ms]. However, BL revealed a smaller phase difference [2 (SEM 1) ms] than that for UL. It was concluded that during maximal BL contraction cortical cellular activities in both hemispheres was more synchronized in amplitude and time course compared with maximal UL contractions. Our data suggested that central common drive existed between the right and left motor areas during the maximal BL handgrip contractions and the amplitude of potentials of both hemispheres was modified by the interhemispheric inhibition mechanism as reported in other studies.     

Quantitative Analysis of Asymmetrical Cortical Activity Based on Power Spectrum Changes

The present study intends to quantitatively analyze power changes in blood oxygenation level-dependent (BOLD) signals, and to investigate functional asymmetry of cortical activity in motor areas during sequential finger movements. A power spectrum method was employed, mainly in contrast with the signal magnitude analysis, to investigate functional asymmetry of motor area cortical activity. Six right-handed subjects were included in the functional magnetic resonance imaging (fMRI) experiments. Both bi-handed and single-handed movements were analyzed. The power spectrum method demonstrated that right-handed subjects exhibited a larger power difference in BOLD signals between task and rest states in the right motor area than in the left motor area. These results showed that more nerve cells were evoked in the right motor area of right-handed subjects. In addition, the power spectrum method was confirmed to be a valid quantitative-analysis method for brain asymmetry analyses.     

奥卡西平对癫痫患者运动皮质兴奋性的影响

目的：利用经颅磁刺激（transcranial magnetic stimulation, TMS）技术来研究奥卡西平（oxcarbazepine, OXC）对部分性癫痫患者运动皮质兴奋性的影响，并与卡马西平(carbamazepine, CBZ)的作用相比较。方法：对38例头颅MRI正常的部分性癫痫患者和20例正常对照进行磁刺激，并记录双侧大脑的静息期运动皮质阈值(rest motor threshold, rMT)、运动诱发电位波幅（motor evoked potential amplitude，MEP amplitude）、皮质潜伏期(cortical latency, CL)和中枢传导时间（central motor conduction time, CMCT）。癫痫组中18例给予OXC治疗，20例给予CBZ治疗，在治疗后第2周末、第4周末分别给予TMS。结果： 癫痫组38例治疗前可能致痫灶同侧大脑rMT高于对侧大脑，但差异无显著(P>0.05)。奥卡西平组可能致痫灶同侧大脑rMT在第2周末和第4周末均明显高于治疗前(P<0.05)，卡马西平组可能致痫灶同侧大脑rMT仅在第4周末时高于治疗前(P<0.05)。癫痫组治疗前后同侧大脑MEP amplitude、CL和CMCT差别均无显著，两侧大脑半球间比较差别也无显著。结论： 头颅MRI正常的部分性癫痫患者可能致痫灶所在半球和对侧半球的大脑皮质兴奋性可能存在差异，OXC和CBZ均能降低运动皮质兴奋性，可能机制为细胞膜钠离子通道阻滞。 TMS是从电生理角度研究大脑皮质兴奋性的可靠辅助工具。     

老年脑卒中后抑郁及血管性认知功能障碍的研究分析

目的 探讨老年卒中患者的抑郁障碍及血管性认知功能障碍发生情况,并进一步研究卒中患者抑郁障碍与血管性认知功能障碍的关系。方法 随机选取我院2016年1月~2017年8月治疗的204例老年卒中患者,采用汉密尔顿抑郁量表、蒙特利尔认知评估量表和简明精神状态检查量表对卒中患者进行评估,观察患者抑郁障碍发生率、血管性认知功能障碍、HAMD得分、MoCA得分及MMSE得分情况。结果 老年卒中患者的抑郁障碍发生率为52.45%,不同年龄间的抑郁障碍发生率,差异有统计学意义（P<0.05）;抑郁障碍患者的血管性认知功能障碍的发生率,高于非抑郁障碍患者（P＜0.05）;不同程度的抑郁障碍患者发生血管性认知功能障碍,差异有统计学意义（P＜0.05）;卒中患者的HAMD得分与MoCA得分及MMSE得分呈负相关（P＜0.05）。结论 老年卒中患者的抑郁障碍及血管性认知功能障碍发病率较高,抑郁障碍的发生对血管性认知功能障碍的发生具有一定影响。     

多普勒超声与同步心电图测定正常人左室收缩期时相的方法学研究

探讨以多普勒超声结合同步心电图定义左室收缩期时相的可行性。采用多普勒超声与同步心电图同时显示主动脉瓣口血流频谱及心电图的波形 ,测定 13例正常人左室收缩期各时相的时间与二维容积参数 ,比较常规法与多普勒超声法的测值之间差异 ;分析两种方法测值之间相关性和一致性。结果 :两种方法测量的左室收缩末期的时间无统计学差异 (P>0 .0 5 ) ,两者具有高度线性相关关系 (r=0 .91,P<0 .0 1)。 Bland- Altm an分析两种方法测值一致性良好 ;两种方法测量的左室收缩末期的容积无统计学差异 (P>0 .0 5 ) ,两者具有高度线性相关关系 (r=0 .97,P<0 .0 1)。两种方法测量的容积一致性良好 ;多普勒法测量的左室等容收缩末期的容积和常规法测量的左室舒张末期的容积经比较无统计学差异 (p>0 .0 5 ) ,两者具有高度线性相关关系 (r=0 .98,P<0 .0 1)。多普勒法测量左室等容收缩末期容积与常规法测量左室舒张末期容积一致性良好。多普勒超声结合同步心电图确定左室收缩期时相的方法是可行的 ,并与常规法具有相互替代性。     

Facilitatory effects of 1 Hz rTMS in motor cortex of patients affected by migraine with aura

We previously showed paradoxical facilitatory effects of low-frequency repetitive transcranial magnetic stimulation (rTMS) on striate and extrastriate cortex of patients suffering migraine with aura. In this study we evaluated the effects of 1 Hz rTMS on the excitability of inhibitory and facilitatory circuits of motor cortex to explore whether the abnormal pattern of excitability extends beyond the sensory cortex also involving motor areas in migraine with aura. Nine patients affected by migraine with aura and eight healthy controls entered into the study. The hot spot for activation of the right abductor pollicis brevis (APB) was checked by means of a figure-of-eight coil and motor threshold (MT) recorded on this point. Nine hundred magnetic stimuli at 1 Hz frequency and 90% MT intensity were delivered at the hot spot. Before and after rTMS, intracortical inhibitory and facilitatory circuit excitability was assessed by means of a paired pulse paradigm (conditioning stimulus 80% MT and test stimulus 120% MT) with two different interstimulus intervals: 2 ms (inhibitory) and 10 ms (facilitatory). Amplitude of the responses was expressed as the percentage of motor evoked potential (MEP) to test stimulus alone. Results showed that in basal condition migraineurs present significantly reduced levels of intracortical inhibition (ICI) compared to controls. More importantly, opposite results were obtained in migraineurs with respect to controls when 1 Hz rTMS was applied. Specifically, whereas intracortical facilitation (ICF) significantly decreased in controls, it significantly increased in migraineurs. ICI levels were not significantly affected by low-frequency stimulation. Our results showed that motor as well as sensory cortex of migraine patients present an abnormal modulation of cortical excitability, where a relevant role is likely played by the inefficiency of inhibitory circuits.     

Electroencephalographic frontal asymmetry and depressive symptoms in the elderly

Although neurophysiological changes of aging are well known, there is still much to learn about cortical asymmetry in older depressed subjects. This study aimed at assessing differences between depressed and normal elderly subjects on alpha asymmetry, and to observe the correlations of this measure with depressive symptoms and quality of life. Thirty-six subjects (14 normal and 22 depressed) were assessed by EEG, depression rating scales, and SF-36. Despite the fact that compared to healthy elderly, depressive elderly subjects showed relatively greater right frontal activity (F4F3) and relatively greater left parietal activity (P4P3); this difference was not significant. The relationship between depression and frontal asymmetry was better observed in healthy elderly, where relatively greater left frontal activity was associated with less depressive symptoms.     

经颅磁刺激对帕金森氏病患者的运动诱发电位的研究

目的： 本研究主要通过经颅磁刺激(TMS)检测帕金森氏病 (PD) 患者的运动诱发电位（MEP）,总结PD患者的MEP特点,探讨PD患者的运动皮质兴奋性。方法：选取健康志愿者20例作为正常对照组（A组）,男12例,女8例,年龄52-79岁,平均(62.3±16.7)岁。通过TMS检测左右两侧MEP,作左右侧比较。选取2007年5月-8月浙江大学医学院附属第二医院神经内科住院或门诊的PD患者共21例（B组）,均症状左右不对称,男12例,女9例,年龄46-80岁,平均(63.3±16.7)岁,按症状轻重程度比较MEP,且将PD组与正常组比较。结果：正常对照组左右侧MEP参数无显著差异。PD组与正常对照组相比,静息运动阈值（RMT）降低,波幅（Amp）升高,皮质潜伏期（CL）缩短,有显著差异,中枢运动传导时间（CMCT）改变无显著差异。PD症状重侧与轻侧相比较,重侧的RMT更低,有显著差异,AMP、CL、CMCT改变无显著差异。结论： PD患者的运动皮质兴奋性增高,且与症状严重程度相关。利用PD患者的MEP特点有助于辅助诊断,有助于评估症状严重程度,以RMT敏感性最高。     

Hemispheric differences in the relationship between corticomotor excitability changes following a fine-motor task and motor learning

Motor performance induces a postexercise increase in corticomotor excitability that may be associated with motor learning. We investigated whether there are hemispheric differences in the extent and/or time course of changes in corticomotor excitability following a manipulation task (Purdue pegboard) and their relationship with motor performance. Single- and paired-pulse (3 ms) transcranial magnetic stimulation (TMS) was used to assess task-induced facilitation of the muscle evoked potential (MEP) and intracortical inhibition (ICI) for three intrinsic hand muscles acting on digits 1, 2, and 5. Fifteen right-handed subjects performed three 30-s pegboard trials with left or right hand in separate sessions. TMS was applied to contralateral motor cortex before and after performance. Number of pegs placed was higher with the right hand, and performance improved (motor learning) with both hands over the three trials. MEP facilitation following performance was short-lasting (<15 min), selective for muscles engaged in gripping the pegs, and of similar magnitude in left and right hands. ICI was reduced immediately following performance with the right hand, but not the left. The extent of MEP facilitation was positively correlated with motor learning for the right hand only. We conclude that the pegboard task induces a selective, short-lasting change in excitability of corticospinal neurons controlling intrinsic hand muscles engaged in the task. Only left hemisphere changes were related to motor learning. This asymmetry may reflect different behavioral strategies for performance improvement with left and right upper limb in this task or hemispheric differences in the control of skilled hand movements.